Boa noite!
Deixo apenas algumas citações que espero que ajudem a clarificar alguns conceitos que me parecem difusos nesta discussão:
Necrotic tissue is dead tissue, (...) changes color from red to brown or lack/purple, as it becomes more dehydrated. Finally, it forms a black, dry, thick, and leathery structure known as eschar. (...) In contrast, slough is a yellow fibrinous tissue that consists of fibrin, pus, and proteinaceous material. (...) The accumulation of necrotic tissue or slough in a chronic wound is of major clinical significance, because it is thought to promote bacterial colonization and prevent complete repair of the wound. in Harding, Keith; Enoch, Stuart (2003) - Wound Bed Preparation: The Science Behind the Removal of Barriers to Healing -
http://www.medscape.com/viewarticle/459733_5"
Necrotic tissue is dead, devitalized, avascular tissue that provides an ideal medium for bacterial proliferation and may inhibit healing. It’s a well-known theory that wound healing is optimized when all necrotic tissue is removed from the wound bed. Necrotic tissue may present as yellow, gray, brown, or black. As it becomes dry, it presents as thick, hard, leathery black eschar. Yellow, stringy necrosed tissue is referred to as slough."
in Baranoski, Sharon; Ayello, A., Elizabeth (2012) - Wound Care Essentials - Practice Principles; editora Lippincott Williams & Wilkins pág. 115.
Aproveito para disponibilizar também o link para um artigo de consenso de Gray et al (2011) acerca de desbridamento. Neste artigo, além de outras informações relevantes sobre viabilidade dos tecidos, são identificados fotograficamente
6 tipos de tecido desvitalizado.
Link -
http://www.wounds-uk.com/pdf/content_9821.pdf .
Deixo já agora também um excerto de um Position Document da EWMA (2004) que narra muito bem o procedimento na abordagem de uma ferida, e dou especial destaque aos tecidos considerados "viáveis":
"
It is important to recognise the characteristics of wound tissue in order to undertake debridement safely and effectively. Healthy tissue is pink or red, and either shiny and smooth or with ‘rosettes’ on the surface, while new epithelium can be seen growing from the wound edge and is pink or pearly white. Non-viable tissue may:
? Be yellow, grey, blue, brown or black
? Have a soft or slimy consistency
? Form a hard, ‘leathery’ eschar.
Debridement is indicated where there is accumulation of callus, slough, fibrous tissue or obviously non-viable tissue. However, it is important to achieve the right balance in the amount of tissue removed."
Link -
http://www.woundsinternational.com/pdf/content_49.pdfEspero que seja útil
Reparei que foi referido que autores defendem que se deve manter a "fibrina" no leito da ferida. Se alguém possuir material que fale acerca disso agradecia desde já a partilha
Tópico: Tecido necrosado VS tecido desvitalizado VS fibrina (Lida 12962 vezes)